Healthcare Provider Details

I. General information

NPI: 1457751760
Provider Name (Legal Business Name): JESSICA KINGSBURY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S. PALATIVE HILL RD. MSC 133
PORTLAND OR
97219
US

IV. Provider business mailing address

615 S. PALATIVE HILL RD. MSC 133
PORTLAND OR
97219
US

V. Phone/Fax

Practice location:
  • Phone: 503-768-7165
  • Fax: 503-768-7167
Mailing address:
  • Phone: 503-768-7165
  • Fax: 503-768-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201405480NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number201405480NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: